Provider Demographics
NPI:1043537640
Name:BOCCARDI, PETER R (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:R
Last Name:BOCCARDI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 PENNSYLVANIA AVE. NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004
Mailing Address - Country:US
Mailing Address - Phone:202-285-9275
Mailing Address - Fax:
Practice Address - Street 1:1350 PENNSYLVANIA AVE. NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004
Practice Address - Country:US
Practice Address - Phone:202-285-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500786631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical